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INTRODUCTION
Suspension trauma syndrome (STS) was first described in a report of autopsies of people who died suspended by a harness in Austria and Spain.[1] There were minimal findings related to traumatic injuries, and it was therefore concluded that the cause of death was due to shock.[1] STS is also known as harness hang syndrome, harness-induced trauma, harness-induced pathology, and orthostatic shock while suspended. It is defined as the development of presyncope symptoms and loss of consciousness if the human body is held motionless in a vertical position forsome time.[2] People with prolonged suspension in a harness can die in an expedited fashion and without significantly associated trauma. This syndrome can occur in people who practise activities using harness systems with a dorsal or chest point of attachment as used by painters and builders of high-rise buildings, towers, bridges, marine platforms, power plants, or with a frontal waist point of attachment in sports and recreational activities such as mountaineering, rock climbing, skydiving, paragliding, via ferrata, canyoning, and caving.[3] It can evolve rapidly leading to the state of unconsciousness and eventually death.[3] The term “harness suspension” was originally used to describe STS, but it is not really the harness that is at issue. Pain and respiratory compromise are the issue more than the trauma per se, and any condition that decreases central intravascular volume prior to suspension (i.e., dehydration, hypothermia, fatigue) increases risk.
The objectives of this study are to review the current literature to describe the pathophysiology of STS, identify predisposing factors, and discuss the controversies regarding its management.
METHODS
Data sources and search strategy
A review of the literature published in English and Spanish languages from 1972 to 2020 on suspension trauma was performed. The preference of the languages is based on the ability of the authors to speak those. An exhaustive review of articles published in Pubmed, Medline, Cochrane Library, MeSH, UpToDate, and Google Scholar was executed. The search words used were harness syndrome, suspension syndrome, suspension trauma, suspension shock, harness hang syndrome, suspension stress, reflow syndrome, orthostatic intolerance, orthostatic syndrome, rescue death, rock climbing, harness accident, combinations of these words, and the use of “and” or “or” when feasible. This work was reported in line with...